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WAL-MART PHARMACY 10-1114
CH063730 BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
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Covered Entity Details
Entity Name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Subdivision Name
BOSTON MOUNTAIN RURAL HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH063730
Entity Address
2263 HIGHWAY 65 NORTH
MARSHALL, AR 72650-1030
Grant Number
H80CS00641
Participating Start Date
4/1/2006
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1114
Pharmacy Address
409 SYLAMORE AVENUE
MOUNTAIN VIEW, AR 72560
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Becky Blair, CFO
(870) 448-5733 Ext: 2008
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/3/2019
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